Abortion stigma: shame on you

Safe and legal access to abortion, like clean drinking water and poverty, is often thought about in ‘third world’ terms. Australia is, after all, the ‘lucky country’, with a not-perfect, but nevertheless top class public health system, right? As we often highlight in our WRAP articles, ensuring access in all of its forms (legal, financial, physical and cultural), is key to improving immigrant and refugee women’s health. Access to choice free from judgement is an equally important factor and can seriously impact on a woman’s health and wellbeing, wherever she happens to live.

The 28th of September is the Global Day of Action for Access to Safe and Legal Abortion, and this year’s Call for Action focuses on addressing abortion stigma. Abortion stigma is one of the main obstacles towards ensuring the availability and accessibility of comprehensive abortion services. Silence, shame, guilt and fear are all very real barriers, not only to accessing safe abortion but to speaking openly about it. And while it’s true that every year, almost all of the 21 million women (approximately) who undergo unsafe abortion are in developing countries (WHO 2011), abortion stigma can be and is experienced by women in the ‘developed’ world.

Although there are clear actions we can take, both in Australia and internationally, to make abortion legal and safe, it will not guarantee that all women have ready access to it. Even in countries such as Australia where abortion is less legally restricted, women can resort to unsafe abortion because of abortion stigma. A case in point: if you’re a non-English speaking immigrant woman on a temporary visa living in a small, rural town with only one health service, it’s doubtful you would have access to culturally appropriate health service or be able to retain medical privacy. (Albury, for example, has about 100,000 residents and one abortion clinic.)

Stigma can manifest itself in many ways. Secrecy, shame or feelings of regret, guilt and fear associated with seeking a termination can impact on a woman’s ability to make an independent and autonomous choice. As Anuradha Kumar and others have highlighted, abortion stigma is in effect ‘compound stigma’ because ‘it builds on other forms of discrimination and structural injustice’. The stigma around abortion is tightly interwoven with other social expectations and stereotypes around gender roles in relation to motherhood, sexuality and family responsibility.

Prevailing social, cultural and religious attitudes within different communities can create and reinforce negative attitudes towards women seeking abortion. These potential pressures are often magnified in rural and regional areas where gossip in one community can mean dishonour for a woman in another. But abortion stigma can also be created and perpetuated through organisations and institutions, as is the case of insurance companies who limit the extent of pregnancy-related cover to international students.

In reality, safe access to abortion is far more complex than making it legal, opening more clinics and making medication available (although obviously this is essential). Without social support, abortion stigma will continue to impact on women’s physical and mental health and well-being long after the decision ‘to abort’ or ‘not to abort’ has been made.

Safe and legal abortion free from stigma and discrimination is a women’s health and human right issue. On Sunday, we call for action for the 26% of world citizens where abortion is prohibited. But we also call for action to develop our thinking on the ways that Australian society, including media representations and government policy, can take the stigma out of the decision-making process for all women who seek an abortion.